James Phillips, MD

Dr Phillips is an Associate Clinical Professor of Psychiatry at the Yale School of Medicine. He is in the private practice of general and forensic psychiatry. In the Yale department, he is involved in residency training, the Hispanic Clinic, and the Global Mental Health Committee. He has a long involvement with the Association for the Advancement of Philosophy and Psychiatry, serving as Secretary and as editor of the Bulletin of AAPP. He has written extensively in the area of philosophy and psychiatry and edited Philosophical Perspectives on Technology and Psychiatry (Oxford 2008) and (with James Morley) Imagination and its Pathologies (MIT 2003). For the past few years, Dr Phillips has been involved in the development of a psychiatric clinic in a never-served Andean city (Ayacucho) in Peru.

A recent case has caused a flurry of opposing opinions. Not surprisingly, transgender advocacy groups have praised the judge's decision that the inmate in question has an eighth amendment right requiring the state to support and pay for sex reassignment surgery.

With DSM-5 scheduled for publication a little more than a year from now, we may safely assume that, barring unannounced surprises from, say, the APA Scientific Review Committee, what we will see on the DSM-5 Web site is what we will get. With that in mind it’s time to review what we will indeed get.

The NIMH Research Domain Criteria (RDoC) project raises many questions about DSM-5 and future DSMs. The first is, does the project play a role in DSM-5? Answer: no. Another question: Will the RDoC play a role in future DSMs? Certainly yes. And further: Will the project cause major revisions in future DSMs? For sure. And finally: What does this say about the status of DSM-5? Let’s consider this.

The DSM does and must involve both science and pragmatism. It must use the science that is available, but it must also make countless judgment calls that are not grounded in solid empirical evidence—and surely it makes sense to consider practical consequences in doing the latter.